Studies on Epidemic Influenza: Comprising Clinical and Laboratory InvestigationsUniversity of Pittsburgh. School of Medicine
History
Studies on Epidemic Influenza: Comprising Clinical and Laboratory Investigations
University of Pittsburgh. School of Medicine
Influenza; Influenza Epidemic, 1918-1919
How many cases of influenza of several days’ illness having about 12,000
leucocytes, a few sticky râles in the chest, but no signs of definite
consolidation, have been observed by the clinicians? These cases recover
without further change, and the diagnosis is handed in as influenza
without a complication being mentioned. In collecting the blood reports
from this group the 12,000 cells accordingly must be considered as
having occurred in a simple influenza. We hold that this is not a case
of uncomplicated epidemic disease. There is undoubted evidence, as is
acknowledged by the clinician, of a bronchiolitis; and how many lungs
showing a bronchiolitis at autopsy fail to have a broncho-pneumonia?
True it may not be demonstrable by our physical examination. This is
often the origin of many high counts in what apparently is considered
uncomplicated influenza.
The blood picture of the pneumonia following the epidemic was more or
less constant, although at the same time the features of the count may
be quite different. One could roughly divide the results into three
groups: (1) leucocytosis, (2) leucopenia, (3) intermediate or normal.
Some pneumonias could be followed during their course through all of
these classes. Before discussing the white count we can briefly dismiss
the other phases of the blood examination by stating that the red blood
cells and hæmoglobin presented nothing by the usual examinations which
was of special significance, or in any way characteristic.
As an example of the group showing a leucocytosis let us follow a
patient through an acute influenzal attack, followed by a pneumonia with
a subsequent recovery. An initial leucopenia, gradually or suddenly
changing into a very moderate leucocytosis (10,000–15,000), was noted at
the onset of the pneumonia. During the course of the complication the
number of cells in the majority of cases increased, but rarely advanced
beyond 20,000. With lysis or crisis the count dropped toward normal, and
by the time the lung signs had disappeared the white cells were at the
usual number, or very slightly increased. The point which seemed to us
to be of importance was that, even although we had a leucocytosis, it
was nothing like the count that one would expect for a lobar pneumonia.
Of course, there were a few high counts, but looking at the group as a
whole they were relatively low. There are a number of variations to this
form of blood picture which we might briefly consider. We have observed
secondary rises in the leucocyte count concurrent with a new lung
involvement. This type was the one so prone to develop into a condition
of non-resolution, fibrosis and ultimate death, with a continuous
moderately high leucocytosis to the end. Another variation which we
learned to fear was the fall of leucocytes to normal or subnormal after
a primary rise, when the clinical course of the case in no way indicated
a crisis or lysis pending. Seemingly, the longer the primary
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